We're from the Government and We're Here to Help

Last week in Mother Jones, Kevin Drum argued that the recent contretemps over the national debt had only a single cause. Defense, discretionary, and interest spending are mostly on a downward slope as a percentage of GDP, he claimed; Social Security is "basically fine"—but not health spending. "The only thing we should be seriously concerned about," he concluded, "is health care spending. Period."

In other words, the federal government's management of its health care programs has turned out to be a financial disaster. So what, according to progressives, is the solution? More government management of health care. Of course.

If Drum is right, then the political fight of 2011 is an astounding development—because Democrats won the political fight of 2010. That fight concerned the Patient Protection and Affordable Care Act, aka ObamaCare—whose stated purpose, as the president put it on numerous occasions, was to "bend the cost curve downward."

To that end, the legislation includes something known as the Independent Payment Advisory Board, or IPAB. IPAB is a 15-member panel whose purpose is to impose cuts on Medicare spending—i.e., to ration care. IPAB is universally despised by conservatives. A lot of liberals don't much care for it, either: More than 70 Democrats wanted it excised from the final version of the legislation, and a number of them have signed onto a measure to abolish the panel.

Yet some object to IPAB precisely because it constitutes what Doug Schoen termed, on The Huffington Post, "a threat to critical medical treatments and services." Democratic Rep. Allyson Schwartz calls IPAB a "flawed policy that will risk beneficiary access to care." In short, they do not want to bend the cost curve downward.

Or at least not by rationing medical treatment. Many are happy to do so by other means. Health and Human Services Secretary Kathleen Sibelius has issued a rule requiring insurance companies to justify rate increases over 10 percent, for instance. The administration also has imposed a medical loss ratio rule under which insurance companies are forbidden to spend less than 80 percent of collected premiums on medical treatment. ObamaCare also imposes a variety of expensive mandates, and it outright forbids low-coverage "mini-med plans" (although the administration is happy to waive that rule for its political friends).

As a result, the business community is scampering for the exits. A survey by McKinsey & Company finds that almost half of all employers say they will stop providing insurance for their workers after ObamaCare goes into full effect. Seventy-eight million Americans may lose their employer-provided coverage.

Perhaps more than that: The National Federation of Independent Business just released a survey showing that 57 percent of companies with 50 or fewer employers also may cease offering insurance. Millions more Americans must then turn to the new state "exchanges" to buy policies heavily subsidized by Washington. ObamaCare drives people from private insurance to government insurance.

Then there are those progressives who would like to see IPAB expanded, not abolished. Harvard economist Greg Mankiw draws attention to a proposal by the Center for American Progress—a Democratic think tank (president John Podesta was Bill Clinton's chief of staff), funded by George Soros, that Time magazine compares to the conservative Heritage Foundation in influence.

The Center has proposed what it calls a "failsafe mechanism" in case, as seems increasingly likely, ObamaCare does not deliver the promised reductions in health-care spending. "Our failsafe would be triggered if, starting in 2020, total economy-wide health care expenditures grow at a rate faster than the economy. Should that happen, we would empower the IPAB to extend successful reforms in Medicare and other public programs to insurance plans offered in the health care exchanges and then potentially to all health care plans , such that the target is met." (Emphasis added.)

Under that scenario, 15 unelected bureaucrats would make the medical decisions for everyone.

And as government involvement in health care spreads, personal freedom retreats. Witness the recent campaign against obesity, now considered a matter of "public health" because government has socialized the costs. First Washington said: "Jim, we are going to make you pay for Robert's health care." Now it says: "Robert, we are now going to make you eat right—because poor Jim here is stuck paying your insurance."

Washington's increasing control of the nation's medical care means your most personal decisions become matters of public debate. There has been much dispute as to whether ObamaCare is a government takeover of health care. There can be no dispute that some of its principal backers want one—and will probably get their wish.

A. Barton Hinkle is a columnist at the Richmond Times-Dispatch. This article originally appeared at the Richmond Times-Dispatch.